Author: NRS Lifespan

 It has been well documented that there are co-occurring conditions with pediatric epilepsy.  The following is a recent review of the literature as to “what to look out for” when your child is diagnosed with epilepsy.

• In a study that included 6635 children with epilepsy, Aaberg et al (2016) found that 78.3% of the children had one or more co-occurring disorders.  These comorbidities included 55% medical disorders, 41% neurologic disorders, and 43% developmental/psychiatric disorders.  In addition, children with complicated epilepsy (epilepsy with additional neurologic or developmental disorders) had higher overall levels of comorbidity than those with uncomplicated epilepsy.
• In another study of 119 children with epilepsy, Dagar et al (2020) found that 41% screened positive for depression on a self-report instrument.  This study reported a strong correlation between anxiety and depression in participants with pediatric epilepsy.
• LaGrant et al (2020) also found a link between pediatric epilepsy and depression/anxiety, 25% of 1042 children had depression and/or anxiety.
• Dagar & Falcone (2020) found ADHD prevalence was 2.5 to 5.5 times higher in participants with epilepsy than those of the healthy participants.
• Record et al (2021) found most common co-occurring conditions with epilepsy was developmental delay at 56%, intellectual disability at 20%, and ADHD at 23%.  There were also 7% of participants that reported autism as a comorbidity.
• Behavioral disorders have also been observed to co-occur with pediatric epilepsy.  In a study of 50 participants, Elkarray et al (2021) concluded that 28% of the epileptic group studied were diagnosed with a behavioral disorder and another 14% were diagnosed with anxiety.  Oppositional behavior was the most common diagnosis at 52%, followed by ADHD at 44%, and major depressive disorder at 18%.

As neuropsychologists, we treat the entire child.  Therefore, if a child was diagnosed with epilepsy, treatment will focus on the neurological condition (i.e. epilepsy), however, also on possible co-occurring conditions.  The aim is to always treat the ‘whole child’ and capture the entire clinical picture.  Accurate diagnosis is the first step to determine appropriate treatment.  Identifying all co-occurring conditions is critical in order to provide thorough and accurate treatment.

If you have any questions regarding your child, please contact our office.

Steven P. Greco, PhD, ABN
Board Certified, Neuropsycholoy

References

Aaberg, Kari Modalsi. (2016). Comorbidity and childhood epilepsy: A nationwide registry study.  Pediatrics 138(3).

Dagar, Anjali. (2020). Screening for suicidality and its relation to undiagnosed psychiatric comorbidities in children and youth with epilepsy. Epilepsy &Behavior 113.

Dagar, Anjali & Falcone, Tatiana. (2020). Psychiatric comorbidities in pediatric epilepsy.  Epilepsy & Behavior 113.

Elkarray, Rana A.Y. (2021).  Prevalence of psychiatric and behavioral comorbidities in pediatric epilepsy. Scientific Journal Pediatrics, 5(4). 813-818.

LaGrant, Brian. (2020). Depression and anxiety in children with epilepsy and other chronic health conditions: National estimates of prevalence risk factors. Epilepsy & Behavior 103.

Record, E. Justine. (2021).  Risk factors, etiologies, and comorbidities in urban pediatric epilepsy. Epilepsy & Behavior 115.

Forgetfulness can be an early warning sign of dementia, but it can also be part of the normal aging process.  The crucial question is:  How can you tell the difference?  Here at Neuropsychology Rehabilitation Services/LifeSpan (NRS|LS), we have been addressing this question for many years; however, with the assistance of the neuropsychological examination (NPE), we have been able to note a difference in patterns regarding clinical populations.

By the time we reach our mid-40s, there is a cognitive change in the average person. That change or cognitive decline is normal.  It is generally stable but slowly worsens with time.  Mild Cognitive Impairment (MCI) and forms of dementia, however, intensifies the person’s difficulties to a greater degree.

MCI is the middle stage between normal aging and the beginnings of dementia.  In MCI, forgetfulness and other thinking changes occurs, but it does not substantially interfere with daily functioning.  With dementia, forgetfulness, language changes, confusion, etc. now becomes more severe.

Here are some common differences between normal aging and signs of dementia:

• It is normal to temporarily forget an acquaintance’s name; it is not normal to forget the names of family members.
• It is normal to misplace things such as car keys; it is not normal to put them in unusual places, such as in the refrigerator.
• It is normal to need to think longer about things or have problems multitasking, but it is not normal to get easily confused.
• It is common to have trouble finding the right words, but it is not common to have trouble taking part in conversations.
• It is normal to forget the day of the week, but it is not normal to forget the season or year.
• It is normal to feel down occasionally, but it is not normal to withdraw or lose interest in activities that you once enjoyed.
• It is normal to get irritable when a routine is broken, but it is abnormal to get upset when in a new place.
• Getting lost while driving, frequent fender benders or traffic violations.
• Repeating the same questions over and over.
• Others notice thinking changes more than the person does who often will deny his/her problems or cover up their mistakes.

While the progression of dementia cannot be stopped, drugs and lifestyle modifications, particularly with MCI can stabilize your condition for as long as several years.  Regular exercise, and maintaining social contacts, reduce stress, and supplements are very helpful.

If you notice that either you or a loved one is struggling with the situations mentioned above, please give us a call for a neuropsychological consultation.  Our staff can direct you in a proper course of action and provide answers for what is going on.

Robert B. Sica, PhD, ABN
Board Certified, Neuropsychology
Principal and Director of NRS|LS

Sometimes it is hard to know if an experience we are having is “normal” or if we should seek help. It can be hard to track progress and know if the things we are doing to improve are working.

If we want to understand something better, we need to break it down into smaller, more digestible pieces. When we look at something in its totality it can feel too big and overwhelming. Let use anxiety as an example.

Anxiety and stress are not always detrimental to our health. In fact, there are very important evolutionary reasons why humans experience these emotions, but we’ll save that for another post. To evaluate our anxiety, we can use these three simple words – FREQUENCY, INTENSITY, and DURATION.

First, we want to take inventory of how often we feel anxious. Is anxiety experienced on a daily basis? If so, is there a specific reason for the anxiety? Do we always experience anxiety in certain situations or environments? What are they? Why? When an unwanted emotion is experienced on a very frequent basis it can evolve into an ever-growing and expanding problem, further impacting areas of our life.

Next, we want to look at the intensity of the emotion. For example, experiencing a moderate amount of anxiety spontaneously when someone cuts you off while driving is considered “normal”. However, experiencing moderate anxiety all day long for no explicit reason is very unsettling. Some people experience very intense moments of anxiety, called panic attacks. Breathing is a very important component to return the nervous system to a more relaxed state.

Lastly, we want to evaluate how long the experience lasts. In addition to making improvements by reducing the frequency or the intensity of an experience, we can look to shorten the length of time we experience an unwanted emotion. If we can reduce the length of a panic attack from 10 minutes to 5 minutes, we have made very significant progress. Finding ways to control these stressful situations is important in order to see success, maintain motivation, and put forth the necessary effort to make change last.

One helpful tip we can follow is to create a sheet to track our experiences and practice efforts. Use this sheet to log the frequency, intensity, and duration of your emotion and focus on using techniques such as diaphragmatic breathing or thought challenging to improve in one or all of these specific areas. If we see our efforts working, it will motivate us to continue and expand our new abilities.

If these situations do not improve with these self-coping mechanisms, please call NRS|LS for a psychological consultation and evaluation.

George Corradino, LPC
Licensed Professional Counselor

Lack of motivation, procrastination, sluggishness, inability to finish tasks in a timely manner, disorganized, scattered, and overwhelmed.  These are some of the common complaints that result in many adults feeling defeated and ineffective.  The underlying cause could be undiagnosed ADHD.

Many adults live with Attention-Deficit Hyperactivity Disorder and don’t recognize it.  The inability to recognize that they are struggling with Adult ADHD could be that symptoms may be mistaken as those resulting from a stressful and chaotic lifestyle.

As such, myths, stigmas, coinciding symptoms, and limited understanding makes identification and diagnosis of ADHD difficult in adults.

ADHD is predominantly considered to be a developmental/pediatric disorder, but there are extensive longitudinal research studies that conclude the prevalence of ADHD-symptomatology in adults.  In simpler terms, these are children who never outgrow their symptoms.

Below are some questionnaires from the Adult Self-Report Scale (ASRS) Symptom Checklist developed by the World Health Organization (WHO), which can be used as a starting point to help you recognize the symptoms of Adult ADHD.  However, it is not meant to replace consultation with a trained health-care professional for accurate diagnoses and treatment recommendations.

Please answer the questions below, rating yourself on each of the criteria shown as occurring Never, Rarely, Sometimes, or Often.

1.     How often do you have difficulty keeping your attention while doing something for work or school, a hobby, or a fun activity?
2.     How often are you easily distracted by something in your environment?
3.     How often do you avoid or delay tasks or work that require a lot of mental effort or thoughts?
4.     How often do you have trouble listening to someone, even when they are speaking directly to you?
5.     How often do you have difficulty organizing an activity or a task that you need to get done?
6.     How often do you make careless mistakes in things such as schoolwork, a chore, or activity, or something at work?
7.     How often do you forget to do something you do all the time, such as missing an appointment or forgetting things such as keys, phones, lunch, etc.?
8.     How often do you have trouble completing your schoolwork, a project, or a responsibility at work, once all the challenging or fun parts have been done?
9.     How often do you feel fidgety, especially when sitting for long periods of time?
10.   How often do you feel like you’re “on the go”, compelled to do things, or feel like you’re “driven by a motor”?
11.   How often do you begin to answer a question before it’s done being asked?
12.   How often do you feel restless – like you want to go out and do something?
13.   How often do you find it difficult to relax, unwind, and just spend quiet time with yourself?
14.   How often do you interrupt others or butt into their conversations?

If you answered “sometimes and/or often” to the above questions, contact NRS|LS to schedule an initial consultation to discuss the concerns for diagnostic clarification and to inform treatment planning.

Diagnostic clarity and appropriate treatment can substantially reduce ADHD-symptoms for improved daily functioning and overall well-being.

Mihir J. Shah, Psy.D.
Clinical Neuropsychologist

Like anxiety, Americans have become so familiar with depression as a commonplace emotional ailment that it is easily overlooked or accepted as state of being (even pre-COVID-19). Clinical depression, though, is a term that describes a cluster of symptoms – cognitive (thinking-based), emotional (mood-based), and physical (body-based) – that undermine functioning and relationships. It can show up in many forms; subtle and insidious like ants eroding the foundation of a house over the course of many years, alarming and implosive like a bridge collapsing one pillar at a time, or anywhere in-between.

For decades we have studied, diagnosed, and treated depression from the outside. We assume it from someone’s pattern of behavior or the consequences it has on grades, absences from work, quality of relationships with other people, weight gain, sleep problems, etc. But, science is increasing clear that the damage that depression is having on the inside is equally troubling. Depression produces inflammation in every cell of our bodies, including our brains, which is why depression can show up in so many physical symptoms in multiple parts of our bodies, such as brain fog, gut issues, chronic pain, skin problems, etc. If depression is long-lasting, the inflammatory response will be long-lasting as well. Over time, the effects of this pro-inflammatory response dysregulates our immune system, meaning that it reduces its ability to turn on when it should (i.e., like a new virus entering our bodies) and turn off when it should (i.e., virus defeated, threat is over).

For this reason, depression is now falling under the umbrella of autoimmune conditions, similar to rheumatoid arthritis, fibromyalgia, Lyme’s, Alzheimer’s disease, and other chronic conditions. Fortunately, depression is more treatable than those conditions. Further, prevention of depression before it initiates those cascading autoimmune effects is highly advised. If interested in preventative or active counseling for depression, contact our clinical health psychologist.

Lauren Gashlin, PsyD
Clinical Health Psychologist